ISSN 2394-7330

International Journal of Novel Research in Healthcare and Nursing Vol. 2, Issue 3, pp: (86-90), Month: September-December 2015, Available at: www.noveltyjournals.com

Prenatal Diagnostics to Determine Fetal Anemia in Thalassemia Carrier Parents Adhi Pribadi Maternal Fetal Divison Obstetric & Gynecology Department, Medical school of Padjadjaran University, Bandung Indonesia

Abstract: Prenatal screening is needed in cases of blood disorders that cause hemolysis and eventually lead to anemia and death of the fetus. At this time a constraint for prenatal diagnostic is a fairly expensive for most levels of the Indonesian economy. DNA analysis at this point considered the most accurate and can determine whether the fetus is exposed to major or minor gene abnormality. The examination for the actual screening is not feasible because can only be done in a particular city and can not be done in every place. Screening of thalassemia, which had been performed abroad, while in Indonesia currently no program for it although new patient increase. The way a simple laboratory has long been known, especially checking MCV and MCH and blood osmotic fragility test (OTOFT) in the mother, but the main choice is fetal chorionic vilous sampling (CVS) or amniocentesis. Both of these tests require examination of DNA that are quite expensive. Ultrasonography is a tool that is commonly used today in the field of obstetrics. Technological advances, especially Doppler ultrasound has become commonly used. Detection of fetal anemia on serial ultrasound, either with or without Doppler can be used primarily to detect anemia in fetuses by parents who have thalassemia carrier. Measurement cardiothoracic ratio (without Doppler) and measurement of peak systolic velocity (PSV) in middle cerebral artery (with Doppler), performed serially can detect fetuses with anemia earlier to allow for further examination and treatment in the pregnancy. Keywords: Fetal anemia, prenatal diagnostic, thalassemia.

1.

INTRODUCTION

Prenatal diagnostic is a term that means to be equated with the actions or the diagnostic make before the fetal born. At this time growing understanding of prenatal diagnostic including genetic pedigree analysis, population screening, genetic counseling and diagnostic testing on the fetus. Although genetic testing can have broad impact on gene transcription family, but the test is carried out at less than 1% of pregnancies.[1] In thalassemia disease is mainly prenatal diagnostic population screening in pregnant women and their partners as well as the fetus. Thalassemia is a major health public problem in some countries in the world. This is especially true threat in countries including thalassemia belt such as Indonesia, but at the moment does not include priority health problems in Indonesia proven at present there is no specific program for the prevention of this disease. The condition causes the disease is devoid of news and almost never exist of health promotion in the past. This condition contrast with other countries that have elimination program of this disease since several decades ago. Southeast Asian countries are quite advanced for this program were Thailand and singapore. Thailand doing disease elimination programs with mass screening approach premarital screening, while Singapore with advanced equipment to approach diagnostic prenatal.[2,3]

Page | 86 Novelty Journals

ISSN 2394-7330

International Journal of Novel Research in Healthcare and Nursing Vol. 2, Issue 3, pp: (86-90), Month: September-December 2015, Available at: www.noveltyjournals.com The discovery of the nature of the case in the general population have been carried out. Lau et al in Honkong get carrier properties (carrier/carrier) of 7.9%.[4] Suhanda get the nature of the medical student population in Bandung,Indonesia.[5] Thomas et al in their study in the UK get a case of the nature of 8.3% the population of pregnant women at the clinic antenatal.[6] Estimates of the carrier in Indonesia between 3-8%, in some areas reached 10% and the estimated birth of new patients is approximately 3000 patients with thalassemia major births per-year by Setianingsih et al study, thalassemia patients reached 32% remaining α, β thalassemia.[7,8]

2. PREMARITAL SCREENING Screening premarital carried out by Europe countries in the 1960s and 1980s and then continued with a prenatal diagnostic to the method of DNA analysis in the case of the parental carrier especially in certain ethnic. Several countries in Asia are approaching screening mass were India, Saudi Arabia, Iran, and Thailand.[9-11] Mass screening is quite effective, especially in countries which were quite more patient. [12-15] Initial screening can be done routinely, including antenatal care clinics (ANC) by measuring the absolute value of the erythrocytes as the value Mean corpuscular volume (MCV) and mean corpuscular hemoglobin (MCH). Such measurement were conventional way to establish suspected a person as a carrier. The value of the reference person suspected carrier of thalassemia carrier was less than 75 for MCV, and the value of MCH was less than 26 (some literature MCV